The AHSN Network Polypharmacy Programme is working with healthcare professionals to address problematic polypharmacy by supporting easier identification of patients at potential risk from harm from multiple medications. Our evidence-based polypharmacy Action Learning Sets (ALS) are being rolled out across England to support GPs, pharmacists and other healthcare professionals who undertake prescribing or medication reviews to understand the complex issues around stopping inappropriate medicines safely. To drive and accelerate changes in practice, delegates complete a quality improvement project to address problematic polypharmacy in their workplace. This poster summary, Improving medication review in older patients at risk of falls due to medication causing low blood pressure, can be viewed here. For more information about the polypharmacy programme, please visit https://www.ahsnnetwork.com/programmes/medicines/polypharmacy/

1. Problem
Patients prescribed multiple medicines with
unintended hypotensive side effects (who are
not also prescribed medication for the
treatment of hypertension), may not have their
blood pressure monitored and are therefore at
risk of hypotension/postural hypotension and
falls.
Results/Data
Aim
To assess the impact of structured
medication review (SMR) by a clinical
pharmacist reviewing older people
prescribed multiple medication with
unintended hypotensive effects, by
trialling the use of the STOPPFall tool1
to aid deprescribing.
Conclusions/Learning
• Lots of polypharmacy with hypotensive side effects. Expected to find patients with low blood pressure or postural drop at initial review,
however didn’t (note small sample size of study/maybe due to patient caseload-under the care of other teams also).
• Actions from SMR’s ongoing-patients still benefitting from SMR by optimising doses, facilitating symptom review by GP/specialists and
ensuring consideration of non pharmacological treatments, as well as reducing other unnecessary medication.
• The STOPPFall tool may be useful for prescribers/staff new to reviewing medication in patients at risk of falls as a starting point to
identify FRID and how to deprescribe these-less useful for staff already experienced in carrying out falls medication reviews.
• The process of shared decision making empowers patients to make their own choices about which medicines to stop, or to continue.
Their choices don’t always align to ours. Patient feedback on the SMR and deprescribing process may be helpful to include in future.
• Remember! Other factors affect falls risk, not just medicines. Its important to ensure a multidisciplinary team approach
to managing falls risk.
Improving medication review in older patients at risk of falls due to
medication causing low blood pressure
Helena Stimpson, Senior Clinical Pharmacist, Community PCN Teams/Proactive Care,
helena.stimpson@nhs.net
Let’s Falls!
1. Lotta J Seppala, Mirko Petrovic, Jesper Ryg, et al. STOPPFall (Screening Tool of
Older Persons Prescriptions in older adults with high fall risk): a Delphi study
by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Age and
Ageing.2021; 50:1189-1199.
The STOPPFall screening
tool includes a
deprescribing tool to
optimise medication review
and aid the stopping of falls
risk inducing drugs (FRIDs).
Polypharmacy
Lack of knowledge amongst
Lack of knowledge amongst
prescribers of Falls Risk
Inducing Drugs or how to
reduce/stop
Hypotension,
postural
hypotension
& Falls
Not enough
monitoring
Patients unaware of
possible side effects
Reduced
hypotension
Reduced
dose of
medication
with side
effect of
hypotension
Requested
Requested
GP/MDT
review of
anxiety &
headache
management
Ensured
Ensured
offered non-
drug options
for managing
depression &
anxiety
Optimised
Optimised
dose of other
medications
e.g.
gabapentin,
paracetamol
Ensured
Parkinson’s
nurse review/
Parkinsons
medication
optimised
0% of patients at first
medication review
had hypotension
(B.P. <90/60mmHg)
or postural
hypotension (BP falls
by ≥20mmHg systolic
or ≥10mmHg
diastolic within 3
mins of standing) ref
NICE.org.uk
Medicines optimisation actions at review
Request GP/
Request GP/
rheumatolog
y review of
pain
(DMARD/
steroids)
Diuretics, antidepressants
(SSRI, SNRI, tricyclic), opiates,
benzodiazepines, Parkinson’s
(levodopa & dopamine agonist)
Which medicines? Blood pressure
Qualitative feedback on
STOPFall deprescribing tool:
Qualitative feedback on
STOPFall deprescribing tool:
Confirms what we already
know/do. Good to have it
written down as a process.
1. Plan
• ID patients from epact data on 3 or 4 medicines with unintended hypotensive effect
• EXCLUDE patients not on proactive care caseload or in a care home
Method
ACT PLAN
STUDY DO
4. Act
• May be helpful to include
STOPPFall screening &
deprescribing tool in induction
pack for pharmacists new to
role and share with pharmacy
and prescribing colleagues
1. Plan
• ID patients from epact data
on 3 or 4 medicines with
unintended hypotensive
effect
• EXCLUDE patients not on
proactive care caseload or
in a care home
3. Study/Outcome measures
• Medicines with unwanted
hypotensive side effect
prescribed
• Blood pressure at review
• Medicines optimisation actions
• Feedback on deprescribing tool
2. Do
• Complete SMR on 5 patients.
• Use the STOPPFall
deprescribing tool to review
each drug identified as a FRID